Facts
- Status
- A
- Credential
- EMT-ADVANCED
- Type
- Individual
- Enumeration date
- 2024-01-10
- Last updated
- 2024-01-10
Licenses
- License VA
- C201503065
- License VA
- C201503065
Location
- Practice location
- 18 GOVERNMENT CENTER LN
- City
- VERONA VA
- Postal code
- 244822639
- Phone
- 540-810-2380
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.